What are the top reasons why people avoid psychotherapy?

young woman with headband

By Joseph Sacks, LCSW

Do you know people who truly need good psychotherapy but seem to be unmotivated to pursue it seriously? Maybe you know someone who started therapy but just when he began to get better, he quit. How do we understand this peculiar self-defeating behavior?

Alice Miller, the famed psychotherapist who explained the role of childhood in emotional illness, explains the top reasons why people avoid psychotherapy in the title of her magnum opus, The Drama of the Gifted Child.

What gift does the child have? He or she has the amazing ability to survive childhood trauma. Children are so fragile and sensitive that any mistreatment or traumatic experience has potentially the power to make them lose their minds completely, and possibly die, much more easily than adults. However they were implanted with a special survival mechanism, that of repressing their overwhelming feelings and that of idealizing the caretakers or others who mistreat them, and blaming themselves for their misfortune. How do we understand this?

What are the top reasons why people avoid psychotherapy?

A child who is mistreated or traumatized feels incredibly intense emotions of fear, hurt, shame, anger and loss. These feelings threaten to potentially drive him or her to lose his mind, therefore he was given a natural survival mechanism of repressing those feelings, allowing him to continue to function more or less normally for the time being. In addition it can often be dangerous for children to express very intense feelings as their caretakers may respond with harsh or unpleasant reprimands. For example many parents will not tolerate a child expressing intense anger towards them. They will rebuke the child for such expression, and so the child often fears that rebuke and learns to repress his feelings allowing him to survive for the time being without retribution from his caretakers. However all of these intense powerful feelings remain very much alive just below consciousness and have a tremendous effect on his lifelong mental health. In other words the child was taught: “When you feel intense emotions don't express them or you may lose your mind! Repress them and be safe. When you have overpowering feelings don't let them out or someone will get angry at you and reprimand or shame you, and you risk losing the attachment to them you so desperately need! You must keep them inside for your own survival!” This lesson becomes an ingrained habit that lasts through adulthood.

Therapy can threaten his outdated, childhood survival mechanism

When a person comes to therapy because of mental health issues caused by those very repressed emotions, the cure would be to bring them out into conscious awareness, process and resolve them. However that ingrained childhood fear of expressing his emotions makes it difficult to do so, and he resists the process of therapy. It is understandable! He's being asked to abandon the very mechanism that has insured his survival until now! Only detailed awareness of these facts and extreme bravery will allow him or her to persevere. A wise and empathetic psychotherapist can give him the support he needs to be successful.

A child must idealize his parents for his very survival!

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Furthermore, a child who is mistreated or traumatized is faced with two possibilities in his mind. He can recognize the fact that the world and his caretakers are indeed hurting him, that they are even somewhat cruel and are not acting in his benefit. However to become cognizant of the fact that the world or his caretakers are not properly taken care of him, in fact there are harming him, is so completely overwhelming and terrifying that no child can consider it even for a moment. Such a realization would create what's called an abandonment-annihilation trauma. Abandonment is the ultimate fear of all children and the thought, “My parents are hurting me, no one is taking care of me,” is a fate worse than death which could drive the child insane. Therefore in order to survive the experience, the child creates a fantasy that preserves the integrity of his support structure. He thinks, “My parents or the world is good to me they're taking care of me. Why do they seem to be hurting me right now? They're doing it for my own good because I deserve it. I was bad.” -Therein lies the genesis of low self-esteem, self-blame, and self-directed anger- “However they are good and have my best interest in mind. They're taking care of me.” This fantasy saves the child from the abandonment annihilation trauma. In addition it has another benefit. It gives the child hope to ameliorate his situation. He thinks, “Since I am bad and it is my own fault that I'm being mistreated, I can change. I will be good. I will be so good that they won't mistreat me anymore.” Therein lies the genesis of perfectionism. In most cases no matter how good the child behaves he continues to be mistreated, indicating to him further that he is bad and deserves it. It is a tragic cycle.

He had to believe he was the bad one

young man looking through blinds

Therefore in order to survive the child must believe that his parents and the world are good. He creates a survival mechanism in his thoughts: “Don't think mommy and daddy are bad. You may then lose your mind. You must think mommy and daddy are good and are taking care of you. You are the bad one.” This habit stays with the person through adulthood. Then when he or she inevitably comes to therapy to deal with the mental health issues generated by such childhood mistreatment, and he is informed that the solution to his problems is to recognize the errors of his parents so he can process the trauma, release his repressed emotions and heal through psychotherapy, he resists. There's a voice screaming in his head: “You must idealize your parents! Your parents were doing it for your own good, you deserved it!” Shattering this whole fantasy as an adult in psychotherapy is possibly the greatest and most profound realization that a person can ever have. His whole world beliefs and thought structure is about to change. He's being asked to abandon the very mechanism that has insured his survival until now. It is quite understandable that many people do not have the strength to face this challenge, and therefore do not pursue psychotherapy. Such is the nature of mental illness. Not only does it cause symptoms but the illness itself often prevents the patient from seeking a cure. 

Never despair of finding healing!

See my blog post, How does psychotherapy work? for an explanation in detail of the steps one must undergo to heal from childhood trauma or mistreatment. Never give up hope that with that work you may heal from even the most difficult situation! With proper professional help, persistent effort and a positive outlook, many people have been healed!

Please be advised that that work needs to be done under the guidance of a wise and empathetic psychotherapist, and it must be a very gradual process, so as not to overwhelm the patient. Have patience with your progress and you will see wonderful results gradually.

For a fascinating discussion of how to treat perfectionism, click here.

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If you would like help understanding what are the top reasons why people avoid psychotherapy, and would like help pursuing therapy from a warm, caring therapist in lower Manhattan,

you may call me at 646-681-1707 for a free 15 minute consultation. I look forward to speaking with you!